Roswell Park Cancer Institute Corporation · Roswell Park Cancer Institute Corporation (PBC) Projected Operating Revenues - Other Revenue In Thousands FY15 FY16 FY17 FY18 FY19 Projected
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Roswell Park Cancer Institute Corporation
Section 203 Budget Filing
Fiscal Year 2015 – 2016
FINAL
Public Authority Relationship with Unit of Government 203.6a
Roswell Park Cancer Institute
The Institute was founded in 1898 by Dr. Roswell Park and became a research institute within the New York State Department of Health in 1927. Roswell Park
was one of the first three institutions designated by the National Cancer Institute as a cancer center. When the comprehensive designation was developed
Roswell Park also received that recognition and as such, is committed to combat cancer through basic research, clinical research and treatment and
professional and public education. Presently there are 41 such centers in the United States. Roswell Park is a cancer research, treatment and educational
facility providing multidisciplinary care in ambulatory care centers, satellite locations, community oncology network sites and a 133 bed hospital. Roswell Park
directly and through its affiliates employ over 3,200 people including researchers, physicians, residents, fellows, nurses and research staff. The primary
physical plant covers 28 acres and several city blocks in downtown Buffalo.
The operations of the Institute transferred from the New York State Department of Health to the RPCI Corporation on January 1, 1999. In order to meet the
demands of the changing health care marketplace and to promote the strengths and capabilities of the Institute, Chapter 5 of the Laws of 1997 added a new
Title 4 to Article 10-c of the Public Authorities Law authorizing the RPCI Corporation. This legislative authorization was intended to change the Institute’s
governance structure to afford it market and managerial flexibility but still maintain the public employee workforce and other state affiliations. Among the
special powers granted by the legislation to the Corporation were the powers to contract with the State to operate, manage, superintend and control the
Institute, and to establish, collect, and adjust fees, rental and other charges in connection with the operation of the Institute.
Pursuant to subdivision 2 of Section 403 of the Public Health Law, the Department, acting on behalf of the State, entered into an Operating Agreement with
RPCI Corporation. Operating responsibility for the Institute was transferred to RPCI Corporation effective January 1, 1999. This transfer gave RPCI
Corporation substantial independence in operating the Institute, including the power to establish operating budgets, to establish and implement strategic
business plans, to create subsidiary and affiliated entities to enter into affiliations and alliances with other health care providers and to establish, collect and
adjust fees, rentals and other charges in connection with the operation of the Institute. This public benefit corporation was a compromise and while operating
flexibility was provided strong ties to New York State remained through the public employee workforce and other state imposed costs.
Revenues generated by the Corporation as a result of operating the Institute are considered to be revenues of the State for the purpose of its bond payment,
and are required to be deposited into the Roswell Park Cancer Institute Debt Service Account of the Health Income Fund for payment of debt service on the
Bonds. The Department retains responsibility for paying debt service on the Bonds. After allowing for accumulation of a debt service reserve for the Institute,
the remaining revenues are transferred to the Roswell Park Cancer Institute Income Account of the Health Income Fund. After allowing for a balance for
refunds these revenues are, in turn, transferred to RPCI Corporation.
RPCI Corporation’s responsibility is to ensure the fiscal and programmatic integrity of the facility. To achieve this object ive, the Corporation has updated the
strategic plan for the Institute which includes major programmatic and scientific, as well as, fiscal goals. Some of the key goals include the recruitment of top-
tier clinical and scientific talent; developing a methodology to monitor the effectiveness of programs and faculty; enhancing financial viability through revenue
and expense controls; building a strong and profitable biotechnology transfer program in collaboration with peer facilities; emphasis on clinical and translation
research, as well as developing and implementing new clinical trials and establishing a cancer disease management and clinical outcomes program.
The Institute is a formally designated unit of the Graduate School of the University of New York at Buffalo and has numerous affiliation agreements with other
educational, research and clinical care facilities. Medical, nursing, cancer research and other allied professional training is provided by the Institute.
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The RPCIC Budget Process Timeline
Dec Sept Oct Feb
Volumes, Grants
+ Inflation
Input completed for:
-Operating Budgets
- New Initiatives
- Capital spending
Mar
Board
approves
Budget
Jan Apr
Nov
203.6 b
Submit
Section 203
materials to
the state
Aug
Requests received for:
- New Initiatives
- Operating Infrastructure
- Capital spending
CEO
approves
Proposed Budget/
Budget Posting
per ABO
Guidelines
Submit
“Condensed
Revenues,
Expenditures &
Changes in
Current Net
Assets”
to ABO
Update December
ABO Submission
4
Capital Allocations will be completed using the
Following Team Structure
203.6 b
Chief Institute
Operations Officer
General Counsel
President / CEOChief Clinical
Operations OfficerPresident / CEO
V.P. of Finance and
C.F.O.
VP for Facilities
Management
Vice President
Information
Technology
AdministrativeFacilities
CommitteeIT Committee
Clinical
Committee
Scientific
Committee
5
203.6 c Budget Assumptions - FY16
Revenue Assumptions:
Base Volumes
Admits +7.3%
IP Days +4.8%
OP Visits +2.7%
Rate Assumptions
Payor increases per contracts
Governmental payor increases per regulations
Sources of Revenues:,
Include Private and Governmental Contracts, Grants and
Donations, and Funding from New York State
Staffing:
At current levels, adjusted for:
Productivity Standards, New Initiatives, Strategic Research
Initiatives and Infrastructure
Future Collective Bargaining Costs:
Bargaining Unit increases for FY2016 included Step and COLA
consistent with current CBA
Inflation:
> Salaries - Steps and COLA factored in per CBA above
> Fringe Benefits - increase consistent with salaries
> Pharmacy (inflation & new drugs) +5.7%
> Medical Supplies, Blood Products, Office Supplies, Purchased Services +2.4%
Programmatic Goals:
> Continue Implementation of Strategic Research Initiatives
> Continue Strategic Recruiting Efforts
> Evaluate Collaborative Opportunities
> Continue Implementation of Strategic Transformation Plan
> ICD10 Implementation
> OmniSeq (Personalized Medicine) Project
6
Challenges and Obstacles – External Forces External forces that challenge our ability to successfully implement Roswell’s vision
for the future:
Current Economic Climate
Outcome of final 2016 NYS Budget
NYS support requested and timing of when funds will be received
Recruitment - Increasing costs and competition
NIH Funding
• Decreases in overall funding while competition for funds increases
• Conclusion of American Recovery and Reinvestment Act (ARRA) funding
• Ongoing Impact of Sequestration
Managed Care
• Increasing role of National players for Commercial and Medicare Advantage plans
• Increasing premium trends are moderating, causing payors to negotiate more aggressively to keep medical expenses at current or moderately higher costs
• Implementation of Insurance Exchanges are leading payors to seek minimal increases on Small Group and Insurance Exchange product offerings
• Increasing use of utilization management and prior authorization tools by payors will provide administrative challenges for ensuring reimbursement for services provided is received
• Increasing use of limited networks and ACO’s may result in less access to Roswell for prospective patients
Federal Deficit impairs Medicare program spending
• Ongoing Impact of Sequestration
Physical capacity to meet demand for clinical services
Ability to invest in accordance with RPCI Strategic Plan
Unknown Impacts of Healthcare Reform
203.6 d
7
203.6 e 203.6 g
CONDENSED BUDGETED REVENUES, EXPENDITURES AND
CHANGES IN CURRENT NET ASSETS
Last Year Current Year Current Year Proposed
(Actual) (Budget) (Estimated) Budget Proposed Proposed Proposed
REVENUE & FUNDING SOURCES FY 2014 FY2015 FY2015 FY2016 FY2017 FY2018 FY2019
Operating Revenues
Charges for Services 440,312$ 462,542$ 486,165$ 526,594$ 557,242$ 584,076$ 612,719$
Rental & Financing income
Other Operating revenues 10,240$ 9,816$ 10,880$ 11,073$ 11,202$ 11,334$ 11,466$
Non-operating Revenues
Investment earnings 860$ 1,657$ 718$ 1,025$ 1,469$ 1,971$ 2,453$
State subsidies/grants 102,600$ 102,600$ 102,600$ 87,100$ 102,600$ 102,600$ 102,600$
Federal subsidies/grants
Municipal subsidies/grants
Public authority subsidies
Other Non-Operating Revenue
Proceeds from the issuance of debt
Total Revenues and Funding Sources 554,011$ 576,616$ 600,362$ 625,792$ 672,513$ 699,980$ 729,239$
EXPENDITURES
Operating expenditures
Salaries and Wages 194,000$ 209,754$ 205,620$ 222,980$ 228,136$ 237,887$ 250,223$
Other Employee Benefits 72,941$ 77,704$ 72,227$ 79,033$ 83,895$ 89,293$ 95,515$
Professional Services and Contracts 67,664$ 82,995$ 75,560$ 99,071$ 87,670$ 87,949$ 88,116$
Supplies and Materials 126,113$ 123,783$ 141,663$ 169,307$ 181,583$ 191,965$ 203,552$
Other operating expenditures 18,410$ 14,193$ 10,856$ 11,714$ 12,265$ 12,460$ 12,945$
Non-operating expenditures
Payment of principal on bonds and financing arrangements 12,239$ 12,858$ 12,858$ 13,279$ 13,055$ 13,726$ 15,689$
Interest and other fiscal charges on debt 8,788$ 8,196$ 8,372$ 7,706$ 7,457$ 6,875$ 6,278$
Subsidies to other public authorities
Capital asset outlay (including CSC) 41,315$ 62,193$ 58,314$ 56,901$ 40,192$ 39,416$ 39,866$
Miscellaneous -$ -$ -$ -$ -$ -$ -$
Total Expenditures 541,469$ 591,676$ 585,471$ 659,992$ 654,253$ 679,572$ 712,183$
CAPITAL CONTRIBUTIONS 12,129$ 19,060$ 18,233$ 9,807$ 1,980$ 1,500$ 1,500$
"Excess (deficiency) of revenues and capital contributions
over expenditures" 24,671$ 4,000$ 33,124$ (24,393)$ 20,240$ 21,908$ 18,555$
8
ROSWELL PARK CANCER INSTITUTE CORPORATIONCash Flow Projections (in millions)
203.5 h
Budget Projected Budgeted Budgeted Budgeted Budgeted
2015 2015 2016 2017 2018 2019
Excess (Deficiency) of revenues and capital contributions over expenditures 4.0$ 33.1$ (24.4)$ 20.2$ 21.9$ 18.6$
Funding of Academic Development (3.1)$ (1.4)$ (2.0)$ (2.1)$ (2.1)$ (2.1)$
OmniSeq Working Capital -$ (0.3)$ (0.3)$ -$ -$ -$
BDF Funds to cover Unfunded Liabilities & Strategic Investments -$ (26.7)$ 56.1$ (15.5)$ (8.6)$ (5.2)$
Working Capital/Other Changes of AWUIL 7.1$ 6.9$ (10.6)$ (0.2)$ (4.3)$ (2.8)$
Annual Unrestricted Cash Impact 8.0 11.6 18.8 2.5 7.0 8.5
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203.5 d Roswell Park Cancer Institute Corporation (PBC)Projected Operating Revenues - Net Patient Service Revenues
($ In Thousands)
FY15 FY16 FY17 FY18 FY19
Projected Budget Budget Budget Budget
Volume Statistics
Admits 4,505 4,834 4,934 5,019 5,106
Days 37,985 39,825 40,420 41,045 41,685
ALOS 8.43 8.24 8.19 8.18 8.16
Visits 202,823 208,225 213,808 219,515 225,392
Direct Patient Service Revenue
RPCI IP Revenue 181,335 193,856 204,594 212,457 220,670
RPCI OP Revenue 227,523 251,592 275,402 291,617 310,156
Other 13,588 29,288 23,969 24,511 25,064
RPCI Total 422,447 474,736 503,966 528,584 555,890
CPP IP Revenue 16,823 17,130 17,822 18,395 18,996
CPP OP Revenue 31,310 34,061 35,696 36,906 38,173
Other - - - - -
CPP Total 48,132 51,192 53,518 55,301 57,169
Total Direct Patient Service Revenue 470,579 525,928 557,484 583,885 613,060
Other RPCI Patient Service Revenue 19,302 5,274 4,291 5,039 4,836
Other CPP Patient Service Revenue 1,055 1,055 1,055 1,055 1,055
Total Other Patient Service Revenue 20,357 6,329 5,346 6,094 5,891
Total Net Patient Service Revenue 490,936 532,257 562,830 589,979 618,951
RPCI Provision for Bad Debts 5,558 6,391 6,331 6,618 6,919
CPP Provision for Bad Debts 746 845 830 857 886
Total Provision for Bad Debts 6,304 7,235 7,161 7,476 7,805
Total Net Patient Service Revenue
Net of Provision for Bad Debt 484,632 525,022 555,670 582,503 611,147
Grants and Contracts 1,533 1,572 1,572 1,572 1,572
Total Charges for Services 486,165 526,594 557,242 584,076 612,719
10
203.5 d Roswell Park Cancer Institute Corporation (PBC)Projected Operating Revenues - Other Revenue
In Thousands
FY15 FY16 FY17 FY18 FY19
Projected Budget Budget Budget Budget
Other Operating Revenues:
Cafeteria 1,662 1,663 1,680 1,697 1,714
Parking Ramp/Surface 2,321 2,279 2,302 2,325 2,348
Aids/Prison Hotline Revenue 270 270 273 275 278
Rebates 1,750 1,750 1,768 1,785 1,803
Shared Services Reimbursements 1,200 1,275 1,288 1,301 1,314
Rental Income 120 120 121 122 124
CPP Physician Salary Support 1,870 1,875 1,913 1,951 1,990
Other 1,686 1,840 1,859 1,877 1,896
Total Other Operating Revenues 10,880 11,073 11,202 11,334 11,466
11
203.5 e
203.5 f Roswell Park Cancer Institute Corporation (PBC)Detail of Salaries and Fringe and Non Personnel Service Operating Expense
In Thousands
FY15 FY16 FY17 FY18 FY19
Projected Budget Budget Budget Budget
Salaries
Salaries and Wage Costs 200,055 217,259 223,388 233,223 245,326
Furlough/Severance Expense/Payments 656 1,491 306 - -
Overtime Payments 2,853 2,001 2,101 2,206 2,316
Premium Payments 2,056 2,230 2,341 2,458 2,581
TOTAL Personnel Service Expense 205,620 222,980 228,136 237,887 250,223
Fringe
NYS Pension Expense & TIAA CREF 27,847 27,788 28,659 29,530 30,427
Health Insurance: Active 19,258 22,108 23,656 25,193 26,705
Health Insurance: GASB Payments 6,498 7,368 8,371 9,535 10,857
Other Fringe 18,625 21,769 23,209 25,035 27,526
TOTAL Fringe Expense 72,227 79,033 83,895 89,293 95,515
Note: The fringe expense includes the cash payment for the retiree's
health insurance, but does not include the GASB 45 accrual
Non Personnel Service Operating Expense
Pharmaceuticals 96,067 119,194 129,689 138,357 147,745
Medical, Blood, Other Supplies 45,596 50,113 51,894 53,609 55,807
Contracted Services / All Other 86,416 110,785 99,935 100,410 101,061
TOTAL Non Personnel Service Expense 228,079 280,093 281,518 292,375 304,613
12
203.6 f Roswell Park Cancer Institute Corporation (PBC)
Reconciliation FY15 Budget to FY15 ProjectedModified Accrual Basis
in Millions
1 Excess (Deficiency) Revenues over Expenses (FY15 Budget) 4.0$
2 Mix of Clinical Services / Clinical Margin 4.7$
3 Timing of Investment in New Initiatives and Strategic Research Initiatives 6.0$
4 Settlement Revenue 8.9$
5 Other Operating Revenue 1.1$
6 Utilities 0.6$
7 Malpractice 2.7$
8 Timing of Capital Investments (including CSC) 3.9$
9 All Other 1.2$
10 Excess (Deficiency) Revenues over Expenses (FY15 Projected) 33.1$
13
203.6 h Roswell Park Cancer Institute Corporation (PBC)
FY 2016 Budgeted # of FTE's and # of Employees
Total # Total # Total #
Functional Classification Employees Full Time FTE's
Clinical / Clinical Research / Academic 1,821.0 1,534.0 1,646.0
Scientific / Academic 184.5 173.5 175.8
Administrative and Other 518.0 478.0 487.9
Total All Functional Areas 2,523.5 2,185.5 2,309.7
Sources of Funding:
The Source of funding for the projected workforce is:
Patient service Revenues - Government and Private Payors
Grants and Contracts
Donations
New York State Funding
14
Roswell Park Cancer Institute (PBC) FY 2016 New Revenue-Enhancement and
Cost-Reduction Initiatives
203.6 i
As part of the Institute’s long range strategic plan, investments are
being made in clinical operations. These investments are critical to
meeting the projected demand for oncology services and increasing
revenue in RPCI’s clinical operations, which are used to support
research and academic missions at the Institute.
Major Gap Closing Components: $ $ i n mi l l i ons
Clinical Margin Improvement 4.9
Strategic Transformation Savings 5.8
New Revenue: $ $ i n mi l l i ons
Practice Acquisitions 17.8
15
Roswell Park Cancer Institute (PBC) FY 2015 – FY2019 Material Non-Recurring Resource
• The Institute is projecting non-recurring capital contribution revenues of
approximately $18.2 million, $9.8 million, $2.0 million, $1.5 million and $1.5 million
in fiscal years 2015 – 2019 respectively. These contributions are expected to assist
in funding the continued growth at Roswell Park.
203.6 j
16
Roswell Park Cancer Institute (PBC) FY 2016 – Material Shift in Resources Between Years
• Capital projects can span multiple years. The entire project is
approved prior to initiation, and due to the magnitude of certain
projects there can be an approved balance to carry forward to
the next fiscal year. Carry over balances are determined and
approved by executive leadership after the start of the new
fiscal year.
203.6 k
17
203.6 l
Proposed
Budget Projection Projection Projection
Borrowed Debt Outstanding FY2016 FY2017 FY2018 FY2019
PBC revenues are 1 DASNY Debt issuance 12/4/03
pledged to repayment 2 DASNY Debt issuance 4/7/04
of the follow ing DASNY 3 DASNY Debt issuance 4/7/04
indebtedness issued 4 DASNY Debt issuance 5/24/05
through New York State 5 DASNY Debt issuance 7/13/2011
Department of Health 6 Capital lease obligations
Debt outstanding at March 31st year end 174.0$ 161.0$ 147.2$ 131.5$
Scheduled Debt Service Payment Principal Interest Principal Interest
For the Year ending March 31
2015 12,858$ 9,458$ (5)$ 154$
2016 13,279$ 8,806$ (1)$ 154$
2017 13,055$ 8,139$ 4$ 154$
2018-2022 81,744$ 29,275$ 99$ 765$
2023-2027 74,679$ 7,190$ 267$ 734$
Thereafter -$ -$ 4,168$ 1,804$
195,615$ 62,868$ 4,532$ 3,765$
*All debt is issued. There is currently no proposed debt.
ROSWELL PARK CANCER INSTITUTE CORPORATION
Borrowed Debt Outstanding projectedin Millions
in 000's
Bonds Capital Leases
18
203.6 l (cont’d)
ROSWELL PARK CANCER INSTITUTE CORPORATION
Purpose of Debt Issuances
PBC revenues are pledged to repayment of the following DASNY indebtedness issued through New York State
Department of Health:
1
On December 4, 2003, DASNY issued debt in the amount of $41,910,000 (RPCIC allocated 85%). Under the
terms of the issuance, interest ranges from 2.0% to 5.25% per annum with interest and principal payments due
through 2024. The bond proceeds were used solely to defease a portion of the outstanding 1994, 1995 and
1996 bond series.
2
On April 7, 2004, DASNY issued debt in the amount of $77,245,000 (RPCIC allocated 95.15%). Under the
terms of issuance interest ranges from 2.0% to 5.0% per annum with interest and principal payments due
through 2024. The bond proceeds were used solely to defease a portion of the outstanding 1994, 1995 and
1996 bond series.
3
On April 7, 2004, DASNY issued debt in the amount of $78,870,000 (RPCIC allocated 95.51%). Under the
terms of issuance interest ranges from 2.0% to 5.0% per annum with interest and principal payments due
through 2023. The bond proceeds were used solely to defease a portion of the outstanding 1994, 1995 and
1996 bond series.
4
On May 24, 2005, DASNY issued debt in the amount of $51,465,000 (RPCIC allocated 95.51%). Under the
terms of issuance interest ranges from 3.0% to 5.25% per annum with interest and principal payments due
through 2026. The bond proceeds were used solely to defease a portion of the outstanding 1996 bond series.
5
On July 13, 2011, DASNY issued debt in the amount of $48,180,000 (RPCIC allocated 74.85%). Under the
terms of issuance interest ranges from 2.0% to 5.0% per annum with interest and principal payments due
through 2025. The bond proceeds were used solely to defease a portion of the outstanding 1998 bond series.
6
On June 1, 2012, RPCIC entered into a capital lease obligation to rent 226 parking spaces for a 35 year period.
Under terms of the agreement, the cost of capital is estimated at 3.4% per annum with interest and principal
payments due through 2047.
19
RPCI is authorized to incur additional indebtedness beyond its current levels. Should the amount of its requested
indebtedness exceed 15% of amounts transferred from the Health Income Fund to RPCI in the previous year, prior
written approval of the NYS Division of Budget is required. RPCI has not assumed that additional indebtedness of this
magnitude will occur in its FY2015 budget. NOTE: RPCI has secured a line of credit with M&T bank to cover
operational cash flow needs should NYS be late in paying its quarterly support payments to the Institute. Interest costs
related to accessing the line of credit have not been included in the FY 2015 budget as we are assuming NYS support
payments will occur in a timely manner.
203.6 l (cont’d)
Ryan/Vanessa update
ROSWELL PARK CANCER INSTITUTE CORPORATION
Debt Service/Pledged Revenues
and Debt limited levels
Debt Service
Debt Service Pledged Percent of
Debt Service as a percentage of Pledged Revenues* FY 2016 Revenues Pledged Revenues
1 DASNY Debt issuance 12/4/03 1,356$ 458,000$ 0.3%
2 DASNY Debt issuance 4/7/04 10,147$ 458,000$ 2.2%
3 DASNY Debt issuance 4/7/04 3,337$ 458,000$ 0.7%
4 DASNY Debt issuance 5/24/05 2,500$ 458,000$ 0.5%
5 DASNY Debt issuance 7/13/11 4,745$ 458,000$ 1.0%
Total 22,085$ 4.8%
*Pledged revenues are defined in accordance w ith RPCI bond documents
20
203.6 m FY2016 Capital Budget Summary
In Thousands (000's)
Budget
2016
Projects funded with Operating Cash:
Total Facilities Capital 14,778$
Clinical, Scientific & Administrative Equipment 12,404$
Information Technology 6,816$
Strategic Initiatives 6,000$
OmniSeq (Personalized Medicine) 4,758$
Subtotal 44,756$
Projects funded with Support from Outside Sources:
Clinical Science Center 12,145$
Total Capital Expenditures 56,901$
Note:
None of the projects is expected to have a material impact on the operating budget.
IT projects include ongoing maintenance costs which are not material to the operating budget.
21
Sec 203.9 CERTIFICATION
By check ing this box, I certify that the OSC Budget Request (Part 203) submission is complete and to the
best of my knowledge and belief after reasonable inquiry, the information provided in this submission is
accurate and correct. This information has been presented to and accepted by the authority's Board.
Chief Operating Officer
Roswell Park Cancer Institute Corporation
Presented to The Roswell Park Cancer Institute Corporation's Board of Directors
on March 3, 2015
Approved by the Board of Directors on March 3, 2015
22
Roswell Park Cancer Institute Corporation (PBC)Section 203 Filing
Changes from Proposed budget posted on 1/30/2015 to budget submitted for Board approval
Schedule Change Description
203.6a Minor updates to Narrative
203.6c Updated Base Volume assumptions
203.6e,g Increase in Revenues (Charges for Services) for FY2015 to FY2019
Decrease in estimates of Salaries and Employee Benefits for FY2016 to FY2019
Increase in estimates of Professional Services and Supplies for FY2016 to FY2019
Adjusted Capital Contributions in FY2017 to FY2019
203.5h Updated Cash Projections based on changes to Net Income and Unrestricted Cash
203.5d Increase in all Volumes & Revenues for FY2016 to FY2019
203.5e,f Decrease in estimates of Salaries and Other Fringe for FY2016 to FY2019
Increase in estimates of Non Personnel Service Operating Expenses for FY2016 to FY2019
203.6h Decreased Total # Employees, Total # Full Time and Total # FTE's
203.6i Added New Revenue for Practice Acquisitions
Increased Amount of Clinical Margin Improvement and Transformation Cost Savings
203.6j Adjusted Capital Contributions in FY2017 to FY2019
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